Published in:
01-11-2012 | Test Yourself: Question
Painful left shoulder
Published in: Skeletal Radiology | Issue 11/2012
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A 19-year-old woman reported a 4 to 5-month history of gradual-onset left shoulder pain. She had no significant past medical history and denied injury. Upon palpation of the left shoulder, she had no tenderness or masses. The left shoulder demonstrated reduced range of motion. The remainder of her evaluation was normal (Figs. 1, 2, and 3).
Fig. 1
AP (a) and tangential (b) views of the left shoulder demonstrate a medullary and cortical lytic lesion of the posterior humeral head with sharp margins but no periosteal reaction, sclerosis, or calcification
Fig. 2
Axial T2-weighted (a), sagittal T1-weighted (b), and sagittal post-contrast fat-saturated T1-weighted (c) images demonstrate an intramedullary lesion breaking through the posterior humeral cortex, but still contained within the joint capsule. The lesion shows signal intensity greater than muscle on the T2-weighted sequence, nearly isointense with muscle on T1-weighted sequence, and slightly inhomogeneous enhancement with adjacent soft tissue edema and enhancement
Fig. 3
Histological evaluation reveals histiocytes with abundant eosinophilic cytoplasm and emperipolesis with phagocytosis of lymphocytes and neutrophils. Mixed inflammatory infiltrate of lymphocytes, neutrophils, plasma cells, and occasional eosinophils is also present
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